Older adults may experience a common experience of anxiety with aging, especially when experiencing social isolation, health issues, and when facing concerns about end of life. This type of anxiety is often seen as adaptive and part of the emotional fabric of aging and coping with aging and does not generally cause significant distress or impair a person’s ability to function.

Excessive anxiety and worry that causes distress or that interferes with daily activities, however, is not a normal part of aging, and needs to be identified and treated by professionals.

There are several types of anxiety disorders. The following are the most common anxiety disorders in older adults.

Agoraphobia. Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms or other embarrassing symptoms (like fear of falling or fear of incontinence). This fear is out of proportion to the actual situation and lasts generally 6 months or longer and causes problems in functioning. A person with agoraphobia experiences this fear in two or more of the following situations:

• Using public transportation
• Being in open spaces (E.g., parking lots, bridges
• Being in enclosed places (e.g., stores or theaters)
• Standing in line or being in a crowd
• Being outside the home alone

The individual actively avoids the situation, requires a companion or endures the situation with intense fear or anxiety. Untreated agoraphobia can become so serious that a person may be unable to leave the house. A person can only be diagnosed with agoraphobia if the fear is intensely upsetting, or if it prevents the older adult from doing normal daily activities.

Panic disorder. Experiencing recurrent unexpected panic attacks is the hallmark of this condition. A panic attack is an abrupt surge of intense fear or discomfort during which time 4 or more of the following symptoms occur:

• Palpitations, pounding heart or rapid heart rate
• Sweating
• Trembling or shaking
• Feeling of shortness of breath or smothering sensations
• Chest pain
• Feeling dizzy, light-headed or faint
• Feeling of choking
• Numbness or tingling
• Chills or hot flashes
• Nausea or abdominal pains
• Feeling detached
• Fear of losing control or “going crazy”
• Fear of dying

Because symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness and may go to a hospital ER.

Generalized anxiety disorder (GAD) includes excessive worry that interferes with daily activities occurring more days than not for at least 6 months. The person finds it hard to control this worry. The anxiety and worry are associated with 3 or more of the following:

• Restlessness
• Feeling keyed up or on edge
• Feeling easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance

A person with GAD may also experience chest pains, headaches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, shortness of breath and dizziness.

Specific phobias. A specific phobia is an intense, irrational fear of a place, thing or event that actually poses little or no threat. Some common specific phobias are fear of heights, escalators, tunnels, highway driving, closed-in spaces, flying, and spiders. Phobias more common to older adults include fear of death, disaster to family, and dental procedures. Facing, or thinking about, these situations or things can bring on severe anxiety or a panic attack (like chest pain, heart palpitations, shortness of breath, dizziness, or nausea).

Social Anxiety Disorder (also called social phobia). Social anxiety disorder is when an individual feels overwhelmingly anxious and self-conscious in everyday social situations. An older adult might feel intense, persistent, and chronic fear of being judged by others and of doing things that will cause embarrassment. Some older adults experience Social Anxiety Disorder because they are embarrassed about being unable to remember names or are self-conscious of their appearance due to illness. A social anxiety disorder makes it hard to make and keep friends. Physical symptoms can include blushing, heavy sweating, trembling, nausea, and difficulty talking.

It’s important to be aware of the signs of anxiety in older adults . Paying attention to the signs will help you access treatment sooner.
Here’s why this is important: the earlier anxiety is identified and addressed, the easier it is to reverse the symptoms.

Here are some signs of anxiety in older adults:

• Excessive worry or fear
• Refusing to do routine activities or being overly preoccupied with routine
• Avoiding social situations
• Overly concerned about safety
• Racing heart, shallow breathing, trembling, nausea, sweating
• Poor sleep
• Muscle tension, feeling weak and shaky
• Hoarding/collecting
• Self-medication with alcohol or other central nervous system depressants

Symptoms of anxiety that are distressing

A 2011 study from the International Journal of Geriatric Psychiatry found that more than 27% of older adults under the care of an aging service provider reported significant symptoms of anxiety that did not amount to diagnosis of a disorder, by caused distress and affected functioning.

It’s thought that 1.2% to 15% of older adults meet criteria for anxiety disorders. Older adults experience specific anxiety disorders at the following rates:

• Agoraphobia has been found to occur most frequently in older adults at 4.9%
• Panic Disorder at 3.8%
• Generalized Anxiety Disorder (GAD) at 3.1%
• Specific Phobias at 2.9%
• Social Phobia / Social Anxiety Disorder at 1.3%

Anxiety in older adults may be linked to several important risk factors. These include:

• Chronic medical conditions (especially chronic obstructive pulmonary disease [COPD], cardiovascular disease including arrhythmias and angina, thyroid disease, and diabetes)
• Overall feelings of poor health
• Sleep disturbance
• Side effects of medications (i.e. steroids, antidepressants, stimulants, bronchodilators/inhalers, etc)
• Alcohol or prescription medication misuse or abuse
• Physical limitations in daily activities
• Stressful life events
• Negative or difficult events in childhood

The death of a loved one can cause a mild, brief anxiety, but anxiety that lasts at least six months can get worse if not treated.

Anxiety and depression commonly occur together in older adults

In older adults, anxiety and depression often occur together. Older adults experiencing both anxiety and depression often have more severe symptoms of both depression and anxiety. It’s important to tell your physician if you’re experiencing symptoms of either condition.

Untreated anxiety is associated with poor health outcomes, such as:

• Cognitive impairment and dementia disorder
• Poor physical health
• Increased disability and impairment
• Diminished quality of life
• Increased caregiver stress

Anxiety is treatable in older adults. The earlier it is identified and addressed, the easier it is to reverse the symptoms. The most effective treatments for older adults with anxiety, include a combination of talk therapy and medications.

Talk Therapy

Talk therapy, counseling or psychotherapy are all terms used to refer to treating mental health conditions with the focus on emotions, thoughts, behavior, and relationships. Therapists are trained in providing therapy to help you better understand thought and relationship patterns, cope with stress, and make changes for optimal health. Cognitive behavioral therapy is proven by research to be an effective talk therapy treatment for anxiety disorders.

Medications

Anxiety Disorders are medical illnesses and medication may have an important role in treatment. There is no one “best” medication for anxiety because each person has different symptoms, medical conditions, and responses to medicines. There are several different classes of medication that may be used to help treat anxiety. A medical professional can help you determine ways to get started with medication or make adjustments to what you’re currently taking.

We recommend meeting with a mental health professional to identify which treatment(s) may be right for you or your loved one.

DO NOT ignore signs and symptoms of mental health concerns. It can help to remember that mental health conditions are highly treatable in older adults. So, lean in, share your concerns, and help your older loved one get connected to providers. Here’s how:

1. Talk with our older loved one about what you’ve been noticing in a straightforward, yet compassionate and concerned way. Here are some ideas:
   • “I’ve been noticing that you haven’t been yourself lately. You seem to be staying in bed a lot and more down than usual. I’m concerned about you.”
   • I’ve been worried about you. Can we talk about what you are experiencing? If not, who are you comfortable talking to?
   • It seems like you are going through a difficult time. How can I help you to find help?
2. Encourage them to see their primary care provider to rule out any medical concerns that may be causing these symptoms. Offer to accompany them to the appointment.
3. Help them get connected with a mental health provider who specializes with older adults. Find a mental health provider who specializes with older adults here.